Kernspintomographische Untersuchung des Schultergelenks beim Hund

Zusammenfassung

Im Zuge der weiterführenden Diagnostik bei Schultergelenkslahmheiten gewinnt die Kernspinresonanztomographie neben Sonographie und Arthroskopie zunehmende Bedeutung. Ziel der Arbeit ist, die normale Anatomie des Schultergelenks anhand von Standardschnitten und-sequenzen unter Verwendung eines supraleitenden Magneten darzustellen. Material und Methoden: Die Untersuchungen wurden an sechs Beagles in einem Kernspintomographen mit einer Feldstärke von 1,5 Tesla durchgeführt. Als Referenz für die Schnittführungen dient die Cavitas glenoidalis. In den Schnittrichtungen sagittal, dorsal und transversal zum gewählten Bezugsobjekt wird die Anatomie des Schulter-gelenks mit den umgebenden Muskeln anhand von Protonen-gewichteten Spinecho- sowie T1-gewichteten Gradientenechosequenzen im Phasenkontrast dargestellt. Ergebnisse: Die an der Bewegung des Schultergelenks beteiligte Muskulatur lässt sich klar darstellen und anatomisch zuordnen. Die klinisch relevanten Sehnenansätze des Supraspinatus- und Subscapularis-Muskels lassen sich beschreiben. Die Bizepssehne ist in ihrem Verlauf durch den Sulcus intertubercularis bis zum Ansatz am Tuberculum supraglenoidale zu beurteilen. Das Labrum glenoidale wird in der transversalen und sagittalen Schnittführung sichtbar. Klinische Relevanz: Die genaue Kenntnis des anatomischen Normalbefundes ist eine wichtige Voraussetzung für eine profunde Dia-gnostik. Wesentlich für die Vergleichbarkeit von Ergebnissen ist eine standardisierte Schnittführung. Die Wahl der Schnittführungen transversal, sagittal und dorsal mit Bezug zu der anatomischen Landmarke der Cavitas glenoidalis stellen leicht reproduzierbare Ebenen dar.

Summary

Objective: Apart from other techniques such as ultrasonography or arthroscopy, magnetic resonance imaging for dogs is increasingly gaining importance in the scope of further diagnostic procedures in canine shoulder lameness. The aim of this study is to present the anatomy of the normal shoulder joint following the recommended slice orientations and sequences in a superconducting magnet. Materials and methods: The examinations were performed in six beagle dogs using a 1.5 Tesla magnetic resonance tomography. The glenoid cavity was chosen as an anatomic landmark for dissection orientation. A long axis through the supraglenoid and infraglenoid tubercle as well as a lateral axis were able to be fixed according to the elliptic shape of the glenoid cavity. A sagittal, as well as a transverse plane were defined perpendicular to these axes. A third plane was chosen, parallel to the surface of the glenoid; described as dorsal to the glenoid cavity. Proton density weighted spin echo sequences, as well as T1-weighted gradient echo sequences opposed phase were used in order to demonstrate the normal anatomic situation. Results: All muscles relevant for the motion of the shoulder joint could be identified and anatomically described by MRI. The main clinical insertions of the supraspinatus and subscapularis tendon were demonstrated. The biceps tendon was made visible through the intertubercular groove all the way to it’s origin in the supraglenoid tubercle. The glenoid labrum was revealed by the chosen transverse and sagittal plane orientation. Clinical relevance: The profound knowledge of the normal anatomical situation is an essential supposition for a valid diagnosis. A standardized slice orientation of the gained images is important for the comparability of findings. The shoulder joint’s anatomy with the surrounding muscles is displayed in sagittal, dorsal and transverse plane of the chosen reference. These clearly defined planes can be easily reproduced.

Schlüsselwörter

MRI - Hund - Schultergelenk - Schnittrichtungen - Sequenzen

Key words

MRI - dog - shoulder joint - plane orientation - sequences

• Literatur

• 1 Assheuer J, Jerosch J, Gottschlich KW, Young IR, Bydder GM. Partial Saturation Recovery Imaging of Posttraumatic Diseases of the Shoulder. Society of Magnetic Resonance in Medicine, 11th Annual Scientific Meeting, Berlin: 08.-14.08. 1992
• 2 Assheuer J, Sager M. MRI- and CT-Atlas of the Dog. Berlin, Oxford: Black-well; 1997
• 3 Bardet JF. Shoulder diseases in dogs. Vet Med 2002; 10: 909-918
• 4 Bardet JF. Shoulder instability and joint pain in dogs and cats. 1st World Orthopaedic Veterinary Congress, Mänchen: 05.-08.09. 2002
• 5 Bruce WJ, Burbidge HM, Bray JP, Broome CJ. Bicipital tendinitis and tenosynovitis in the dog: a study of 15 cases. New Zeal Vet J 2000; 48: 44-52
• 6 Evans HE. The skeleton; The muscular system. In Miller’s Anatomy of the Dog. Evans HE. ed Philadelphia: Saunders; 1993: 122-218
• 7 Gerwing M, Kramer M. Die Sonographie des Schultergelenkes und seiner umgebenden Weichteile beim Hund – Teil B: Sonographische Diagnostik von Erkrankungen im Bereich des Schultergelenkes. Kleintierprax 1994; 39: 141-156
• 8 Liebich HG, Maierl J, König HE. Verbindungen der Knochen der Schulter -gliedmaße (Articulationes membri thoracici), Schultergelenk Articulatio humeri. In Anatomie der Haussäugetiere: Lehrbuch und Farbatlas fär Stu- dium und Praxis, Band I, Bewegungsapparat. König HE, Liebich HG. Hrsg Stuttgart, New York: Schattauer; 2004: 159-161
• 9 Long CD, Nyland TG. Ultrasonographic evaluation of the canine shoulder. Vet Radiol Ultrasound 1999; 40 (04) 372-379
• 10 Kramer M, Gerwing M. Die Sonographie des Schultergelenkes und seiner umgebenden Weichteile beim Hund – Teil A: Die sonographische Anatomie des Schultergelenkes und seines Weichteilmantels. Kleintierprax 1994; 39: 71-80
• 11 Mitchell RAS, Innes JF. Lateral glenohumeral ligament rupture in three dogs. J Small Anim Pract 2000; 41: 511-514
• 12 Muhumuza L, Morgan JP, Miyabayashi T, Atilola MAO. Positive-contrast arthrography: A study of the humeral joints in normal Beagle dogs. Vet Radiol 1988; 29 (04) 157-161
• 13 Muir P, Goldsmid SE, Rothwell TLW, Bellenger CR. Calcifying tendinopathy of the biceps brachii in a dog. JAVMA 1992; 201 (11) 1747-1749
• 14 O’NeillInnes JF. Treatment of shoulder instability caused by medial gleno-humeral ligament rupture with thermal capsulorrhapy. J Small Anim Pract 2004; 45: 521-524
• 15 Rapp E, Lechleitner E, Plenk H. Histological studies of a tongue-shaped formation at the intertubercular groove in the shoulder joint of the dog. Zen-tralbl Veterinarmed A 1992; 39 (04) 289-300
• 16 Sager M, Assheuer J. Injuries of the glenoid labrum and their non invasive diagnosis. 6th Annual Meeting of the European Society of Veterinary Orthopaedics and Traumatology (E.S.V.O.T.), Rom, 24.09. 1992
• 17 Sager M, Assheuer J. Non bony lesions of the scapulohumeral joint in the dog – the difficulty of diagnosis. 2nd Annual Scientific Meeting of the European College of Veterinary Surgeons, Cambridge, 02.-04.07. 1993
• 18 Sager M, Assheuer J. Shoulder lameness – the importance of supporting structures of the scapulohumeral joint. Annual Meeting of the European Association Veterinary Diagnostic Imaging, (I), Alghero, 09.-12.09. 1993
• 19 Sager M, Assheuer J. A contribution to injuries of the supporting structures of the scapulohumeral joint in the dog. 21st Annual Conference of the Veterinary Orthopaedic Society, Snowbird, Utah, 26.02.-05.03. 1994
• 20 Sager M, Assheuer J. A proposal for standardization of MRI-examinations in the joints of the dog. 10th International Veterinary Radiology Association Meeting, Philadelphia, 01.-06.08. 1994
• 21 Sager M, Assheuer J. Approved imaging protocols for MRI-examination in the joints of the dog. 22nd Annual Conference of the Veterinary Orthopaedic Society, Whistler, British Columbia, 04.-11.03. 1995
• 22 Sager M, Assheuer J. Chronic shoulder lameness in the dog – MRI findings in primary non-bony alterations. 12th Meeting of the International Radiology Association, Obihiro, Japan, 21.-25.08. 2000
• 23 Sager M, Assheuer J. The glenoid labrum – an important detail in the patho -logy of the scapulohumeral joint in the dog. 12th Annual Conference of the European Association of Veterinary Diagnostic Imaging, Naples, 05.-08.10. 2005
• 24 Schaefer SL, Forrest LJ. Magnetic Resonance Imaging of the Canine Shoulder: An Anatomic Study. Vet Surg 2006; 35: 721-728
• 25 Stobie D, Wallace LJ, Lipowitz AJ, King V, Lund EM. Chronic bicipital tenosynovitis in dogs: 29 cases 1985-1992. JAVMA 1995; 207 (02) 201-207
• 26 Suter PF, Carb AV. Shoulder arthrography in dogs – radiographic anatomy and clinical application. J Small Anim Pract 1969; 10: 407-413
• 27 Van Bree H, Verhaeghe B, Maenhout D. Positive contrast arthrography of the dog’s shoulder with meglumine-sodium diatrizoate. J Vet Med A 1989; 36: 421-430
• 28 Wall CR, Taylor R. Arthroscopic biceps brachii tenotomy as a treatment for canine bicipital tenosynovitis. J Am Anim Hosp Assoc 2002; 38: 169-175